By Derek Turner
Aubrey Hand laced his shoes and stepped out onto the track. Men and women took notice, pausing their conversations and easing over closer to see what would happen next.
Hand looked down at his feet, took a breath and took off. Cheers erupted. It felt like a victory. But this is a long race, and he’s nowhere near the finish line.
On that day in late 2016, he was far from South Carolina, where he once ran cross country and track at Spartanburg Methodist College. He was at Walter Reed National Military Medical Center in Bethesda, Maryland, jogging for the first time since doctors amputated his left leg below the knee.
Four years earlier, as the senior airman drove back to base at the end of a route clearance mission in Bagram, Afghanistan, a 200-pound homemade bomb exploded beneath his vehicle.
In the moment, Hand ignored the pain. He got out of the vehicle, secured the area, waited for help to arrive and returned all of his fellow troops alive that day. But the blast shattered his left heel, ravaging the tendons, joints and cartilage from his foot up through his ankle.
The years that followed included one surgery after another. He tried every brace he could find, every orthotic he could slip into his shoe. He walked with a cane or scooted along on a knee cart. He begrudgingly accepted a medical retirement.
“I came to the realization that, if it’s not going to get any better, why keep it?” Hand said.
On July 1, 2016, doctors took his foot and part of his left leg.
The spectators who months later cheered his progress on the track were fellow amputees, people who knew the importance of that moment. They were prosthetists and occupational therapists and physical therapists, people whose careers are dedicated to helping a generation of American service members learn to live again without limbs.
Together, they are part of a giant support system for the nearly two dozen patients recovering at Walter Reed’s amputee clinic.
Well over 1,500 American troops have lost a limb since 2001, in Afghanistan or Iraq or other deployments around the world. Walter Reed — first at the old campus in Washington, D.C., and now at the new facility in Bethesda — is where they take their first steps toward a new reality.
Making Them Whole Again
In the fabrication room, the pieces lay scattered across rows of long tables. The sockets and the joints. The feet and the hands.
This is where a team of certified prosthetists, technicians and administrative staff, more than a dozen in all, create and assemble an assortment of prosthetic limbs and attachments, empowering patients to regain mobility and independence, returning them to the life they want to lead.
Prosthetist Todd Sleeman joined the team at Walter Reed in 2011, shortly after the volume of incoming patients peaked around the turn of the decade. At one point, nearly 250 amputees lived on Walter Reed. That number has fallen, mercifully, to around 20 or 25.
Sleeman works closely with his patients, learning their needs in the present and their goals for the future. Every socket — connecting the prosthesis to the end of the limb — is made in house, cast and molded to snugly fit each patient.
Team members order other pieces of the prosthesis from outside companies and then assemble the elements at Walter Reed to create a personalized limb – often multiple limbs – for each patient.
Sleeman builds prosthetics specifically for lower extremities.
“We’ve used over 120 different types of feet,” he said. “Add that in with all the different styles of knees. It really comes from having years and years of experience, knowing what will work for them starting out but also knowing specific knees and feet for other activities.”
The opportunity to serve young, fit, athletic and motivated patients was one of the factors that brought Sleeman to Walter Reed. He and his colleagues try their best to create whatever those patients need. Working for the U.S. military frees them from some of the limitations faced by their civilian counterparts.
Sleeman was attracted to “the opportunity to not deal with insurance hassles and be able to make someone a running leg, a climbing leg, a wrestling leg, a leg for swimming,” he said. “The other day I made someone a leg specifically for biking. … The guy decided he wanted it, so I ordered it and spent four or five hours making it. In the outside world, I wouldn’t have that luxury.”
In less than two years after his amputation, Hand has feet designed for everyday use, he has two types of running feet and an extreme foot designed for snowboarding, mountain biking or motocross. He planned to get a foot designed just for golf.
Though he may have lost a limb, he said, “I have a variety of feet.”
For 11 years, Joe Butkus has followed the ebbs and flows of our nation’s military conflicts by watching new patients arrive at Walter Reed.
Butkus, an occupational therapist, can tell when a conflict has evolved or tactics have shifted by the types of wounds that patients arrive with. He begins by explaining to the patient and their loved ones what occupational therapy entails.
“Nobody knows who we are,” Butkus said. “Usually people don’t know about it until they have some kind of trauma.”
In short, occupational therapy helps patients regain independence by re-learning basic tasks under their new set of circumstances. From feeding themselves to cooking and cleaning, all the way up to driving a car and preparing for job interviews, occupational therapy prepares patients for a return to everyday life.
At Walter Reed, the process begins inside the patient’s hospital room, with tasks as small as learning to use the call button. The therapy progresses as the patient does.
“Even from the beginning, simple things like how to load your wheelchair into the car and get your wheelchair out of the car by yourself,” Hand said. “It doesn’t seem like a lot, but when you have one leg and you’re trying to balance and wheelchairs aren’t exactly lightweight, it’s a struggle.”
Hand lost his leg below the knee. Relative to some of the more severe amputee cases, his recovery is less complex. Patients with above-the-knee amputations, or even multiple amputations, face a longer road. Patients with upper-extremity amputations face different challenges than patients with lower-extremity amputations.
“It can be years,” Butkus said. “We try to get them as far along as we can independence-wise — independent in the community, education, recreation.”
Of the four quadruple amputees who have come through Walter Reed, each has driven themselves out when they left. That success is the result of adaptive technology and long hours of hard work.
Occupational therapy patients at Walter Reed can be found throughout the rehab facility. One area features a full kitchen where they can practice making their own meals. It can be challenging physically — navigating the kitchen and preparing the food. In some cases, it’s difficult mentally because patients with traumatic brain injuries can struggle to follow instructions or remember the necessary steps.
You might also find patients assembling elaborate structures using blocks or LEGOs, an excellent way to improve focus and regain fine motor skills.
Again and again, Butkus has watched the process play out, taking satisfaction as each patient grows independent and confident, ready to start their life again.
“It’s that transition from their worst day ever to recognizing there’s more and more possibilities,” he said. “To be able to support someone in the right way on their own personal journey with that is a real honor. I look forward to it every day.”
Not long after physical therapist Kyla Dunleavy arrived at Walter Reed in 2003, she received an exciting, if challenging, invitation.
Annette Bergeron, who led the physical therapy team, asked Dunleavy to join her in the newly formed amputee clinic.
“Geez, I’ve worked with about three amputees in my life,” Dunleavy remembered telling Bergeron. “Diabetic, not high-functioning. I don’t know anything about amputees or prosthetics.”
“None of us do,” replied Bergeron, a former Army lieutenant colonel. “We’re all figuring this out.”
And in the years that followed, as hundreds of amputees streamed into their clinic, they did figure it out. They learned, they adapted and they gave patients the physical tools to adjust to their new lives.
The physical therapy clinic at the new Walter Reed is spacious and open. Dunleavy is one of four physical therapists and two technicians leading patients through exercises aimed at gaining strength and mobility. The clinic is filled with reliable, low-tech equipment — tables and mats, parallel bars and exercise balls — as well as some of the most high-tech machines to hit the market. A walking track encircles it all, with straps descending from the ceiling to help support a patient’s weight as they first learn to walk again.
“We get them once they’re stable, they’re independent in transfers,” Dunleavy said. “They can bring themselves down in their wheelchair. We start them with conditioning exercises, strengthening on the mat, balance and core work. We teach them how to take care of their limb and prepare them for using the prosthesis.”
Inside the clinic, a unique dynamic takes shape. The patients see one other every day. They encourage each other and compete with each other.
Medal of Honor recipient Florent Groberg saw it firsthand when he visited the clinic. An Army captain, Groberg was medically retired after sustaining severe injuries in Afghanistan. During the visit, friendly small talk with patients took a turn. One of them challenged Groberg to crank out some reps on the bench press.
“It’s very much a military culture,” Dunleavy said. “This is the snakepit in here.”
And no one is immune. During the last months of his presidency, Barack Obama arrived for an unpublicized visit. The president asked Dunleavy to show him some of the exercises she does with patients.
Under Dunleavy’s instruction, the commander in chief completed a series of agility drills, nothing too strenuous. Then a patient suggested she challenge Obama to do the two-foot box jump.
“No, I don’t want to ask him to do that,” Dunleavy said, imagining the president of the United States injuring himself in her clinic.
“What? You think I can’t do this?”
He did it three times. Dunleavy exhaled.
Of course, this culture thrives because the physical therapists are no pushovers, either. They’ve learned what it takes for patients to reach their goals, and they know how to get their patients to put in the effort required.
Hand credits much of his progress to Julie Castles, his primary physical therapist.
“If my legs are sore, Julie doesn’t care,” he said. “I don’t get babied. That motivates me. If somebody let me be lazy, I’d probably just be lazy sometimes. You don’t feel like working out every single day. Here, she doesn’t care. You’re going to work out.”
Finishing the Race
Since his amputation, Hand learned to walk with his prosthesis. He learned to run with his prosthesis. He also learned to snowboard — something he never did with two good legs.
He traveled with fellow veterans to Breckenridge, Colorado, for a snowboarding trip. He had another trip set for Vail later in the year.
Since the day he jogged for the first time after his amputation, Hand has picked up the pace, growing more comfortable doing something that once came so natural.
“I love to run,” he said. “Just get out on a road and go, not think about anything else.”
It’s different now, he admits. He carries his body differently. He uses his arms differently. But he’s getting there.
Each day he gets closer to the finish line.
–Derek Turner is a freelance writer and a former senior editor of On Patrol, the magazine of the USO.
You can send a message of support and thanks directly to service members via the USO’s Campaign to Connect. Your messages will appear on screens at USO locations around the world.
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